Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Texas Health Science Center at Houston, Houston, TX.
Medical Critical Care Services, Inova Fairfax Medical Center, Annandale, VA.
J Bronchology Interv Pulmonol. 2022 Jul 1;29(3):224-237. doi: 10.1097/LBR.0000000000000872. Epub 2022 May 27.
Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction with endobronchial valves (EBVs) have reported improvements in lung function, breathlessness, and quality of life through randomized clinical trials, with less morbidity as comparted to Surgical Lung volume Reduction. We here present a Meta-analysis and systematic review of bronchoscopic lung volume reduction in advanced chronic obstructive lung disease patients.
PubMed (NLM), Embase (Elsevier), and Web of Science (Clarivate Analytics) search was conducted using a combination of keywords and subject headings. The search was confined to the last 15 years and was completed on October 23, 2020. Only placebo-controlled randomized control trials of emphysema patients with EBV were included. Quality assessment was done by 2 independent reviewers.
Nine studies were included for the meta-analysis with a total number of 1383 patients of whom 888 received EBV and 495 standard of care (SOC) medications. Our Metanalysis show statistically significant improvement in forced expiratory volume in first second, percentage forced expiratory volume in first second, St. George's respiratory questionnaire, and 6-minute walk distance in EBV group compared with SOC. Residual volume had statistically significant reduction after EBV placement compared with SOC. These differences continued to be present during short-term (<=6 mo) and long-term follow-up (>=6 mo). These improvements were even higher when the EBV patients'. Collateral ventilation was negative/fissure was intact (CV-/FI >90%). The rate of hemoptysis and pneumothorax was higher in the EBV group compared with SOC, however, did not lead to increased fatal outcomes.
In conclusion, EBV has favorable effects on patients' outcomes in patients who have heterogeneous emphysema particularly with no collateral ventilation.
治疗晚期肺气肿的药物疗法获益有限。支气管镜肺减容术（endobronchial valves，EBVs）通过随机临床试验报告了改善肺功能、呼吸困难和生活质量的效果，与外科肺减容术相比发病率较低。我们在此对晚期慢性阻塞性肺疾病患者行支气管镜肺减容术进行了荟萃分析和系统评价。
使用关键词和主题词的组合，对 PubMed（NLM）、Embase（Elsevier）和 Web of Science（Clarivate Analytics）进行了检索。检索范围限于过去 15 年，并于 2020 年 10 月 23 日完成。仅纳入接受 EBV 治疗的肺气肿患者的安慰剂对照随机对照试验。由 2 名独立评审员进行质量评估。
纳入了 9 项研究进行荟萃分析，共有 1383 例患者，其中 888 例接受 EBV 治疗，495 例接受标准治疗（SOC）药物治疗。我们的荟萃分析显示，与 SOC 相比，EBV 组的用力呼气第一秒容积、用力呼气第一秒容积百分比、圣乔治呼吸问卷和 6 分钟步行距离均有统计学显著改善。与 SOC 相比，EBV 放置后残气量有统计学显著降低。这些差异在短期（<=6 个月）和长期随访（>=6 个月）中仍然存在。当 EBV 患者的侧支通气为阴性/裂隙完整（CV-/FI >90%）时，这些改善更为明显。与 SOC 相比，EBV 组的咯血和气胸发生率较高，但没有导致死亡率增加。
总之，EBV 对异质性肺气肿患者，特别是无侧支通气的患者的预后有良好的影响。
